Analysis and management of missing intrauterine contraceptive device threads in a tertiary care hospital

Abstract

Background: Intrauterine contraceptive devices (IUCDs) are a common method of contraception adopted for birth spacing in India. Copper T (CuT) 380A is marketed by the government free of cost, which makes it widely available to the patients in need. But a common problem of missing threads leads to an unwanted complication, which needs to be analyzed. Materials and methods: This is a retrospective analysis of patients with missing CuT threads attending the outpatient department (OPD) of gynecology of Mahatma Gandhi Medical College, Puducherry, over a 3-year period between 2017 and 2019. Data regarding patients complaints, timing and place of insertion, obstetric history, ultrasound report, and method of retrieval were analyzed. Results: Out of 75 users of IUCD attending OPD of gynecology over the last 3 years, 28 patients came with missing IUCD threads. Out of 28, 2 patients had spontaneous expulsion, 6 opted for continuation after confirming its normal placement within the uterine cavity, whereas 20 patients opted for retrieval. The most common reason for removal was the need for conception (60%). In 46.4% of cases, IUCD was found embedded in the myometrium and 50% required diagnostic hysteroscopy. Use of ultrasound during retrieval helped in around 50% of cases. Difficulty in retrieval was seen in two cases whereas perforation was seen in one case. Conclusion: Most of the missing IUCD threads were found in patients with history of previous cesarean and though ultrasound in most cases revealed IUCD within the uterine cavity, in few cases it was embedded in the myometrium making retrieval difficult requiring an OT setup.